NEW YORK - Doctors and hospitals seem to use personal digital assistants mainly for billing and keeping schedules. But
Redmond Burke, a Miami heart surgeon, sees the devices as life-saving tools that allow him to keep track of the infants on whom he operates. In his operating room,
Palm
handhelds spearheaded the development of new ways to track the progress of tiny hearts.

Redmond Burke and Jeffrey White

When Burke, 42, became chief of cardiac surgery at Miami Children's Hospital in 1995, he went looking for an engineer who could help him redesign his surgical tools to allow him to operate on babies' hearts by making only small holes in the chest. "The adult instruments simply didn't fit," he says. But at the same time, he had his eye on another problem: keeping track of patient information before and after he operated. "I vowed that we would keep tabs on every baby we touched."

Medical diagnosis requires that the right information reach the right doctors at the right time. The results of a single disconnect are grave: An estimated 50,000 deaths per year result from medical errors. In theory, computer systems, including handhelds, could cut down on these deaths by improving the flow of information, but doctors have been slow to adopt them.

While meeting with up-and-coming engineers at the University of Miami, Burke, a self-confident, Harvard-trained doctor, met a Ph.D. student named
Jeffrey White, now 30. The two seized on the potential of Palm handhelds, then new to the market, as a way of keeping close tabs on Burke's patients. "The visual image I had with Jeff," Burke says, "was that I wanted to have one hand on a sick baby and the other hand on the sick baby's data."

It wasn't the first time that Burke had utilized computers as a method of keeping track of his patients. He says his background made him ready to accept new technology; Burke grew up near the Silicon Valley garage where
Steve Wozniak
built the first Apple
computer, and he comes from a family of engineers.

As soon as he took the helm at Miami Children's Hospital, Burke created what he believes is one of the first relational databases ever used in a hospital. The database, however, was a primitive affair, built using
Microsoft
Access on a single desktop computer. Patient information was transcribed from index cards, and doctors and nurses didn't have access to all that information while examining their patients.

The PalmPilot solved that problem, and allowed Burke and White to start designing a system that kept track of infants' information wirelessly. Within three months, the doctors and nurse practitioners on Burke's staff had tossed away their index cards and were relying entirely on their handhelds.

But Burke still wasn't satisfied. Eventually, he turned to a startup called
Teges, founded by Jeff White's mother,
Christine White, to put patient information on a secure Web server that allowed it to be sent encrypted to doctors' handhelds and to be accessed securely by any computer with a Web browser. Burke's staff adopted the Teges system within days. (Burke is not an investor in Teges.)

Generally, hospitals have jumped at handhelds as a way to make billing more efficient. For instance, Long Island's North Shore-Long Island Jewish Hospital system instituted a billing program that resulted in a 290% return on investment, but is only now developing a system that will put clinical information on handheld computers that doctors carry on their rounds.

"Doctors are clearly very busy and aren't likely to adopt anything that changes their routine a whole lot," says
Patrick Wack, chief executive of
IntraLinks, an e-commerce firm that has designed file-sharing systems used for clinical trials run by
AstraZeneca. "If you look at why computer billing got adopted, a lot of it had to do with Medicare's desire to use computer billing systems."

What may have changed that dynamic in Miami was that a surgery chief was pushing for the changes himself. The Teges system, Burke says, allows babies to be tracked moment to moment, with not only standard clinical data but also photographs. "When you look at the kids in bed," Burke says, "every doctor can tell how they're doing."

One telling example: On the third day that the new system was implemented, the head of Burke's intensive care unit logged onto it from home at 3 AM and saw that one child's heart rate was elevated. "It was a subtle thing that only this guy would have picked up on," Burke says.

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